{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:03:51Z","timestamp":1793084631054,"version":"4.5.0"},"reference-count":79,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,3,1]]},"abstract":"<jats:p>Objective.\u2003As part of a long-term study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we set out to delineate the occurrence and course of otitis media during the first 2 years of life in a sociodemographically diverse population of infants, and to identify related risk factors.<\/jats:p><jats:p>Methods.\u2003We enrolled healthy infants by age 2 months who presented for primary care at one of two urban hospitals or one of two small town\/rural and four suburban private pediatric practices. We intensively monitored the infants' middle-ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 2 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated infants for otitis media according to specified guidelines.<\/jats:p><jats:p>Results.\u2003We followed 2253 infants until age 2 years. The proportions developing \u22651 episode of middle-ear effusion (MEE) between age 61 days (the starting point for data analysis) and ages 6, 12, and 24 months, respectively, were 47.8%, 78.9%, and 91.1%. Overall, the mean cumulative proportion of days with MEE was 20.4% in the first year of life and 16.6% in the second year of life. Tympanostomy-tube placement was performed on 1.8% and 4.2% of the infants during the first and second years of life, respectively. By every measure, the occurrence of MEE was highest among urban infants and lowest among suburban infants; these differences were greatest in the earliest months of life.<\/jats:p><jats:p>Overall, unadjusted mean cumulative proportions of days with MEE were higher among boys than girls, higher among black than white infants, and higher among Medicaid than private health insurance enrollees. Cumulative proportions of days with MEE varied directly with the number of smokers in the household and with the number of other children to whom infants were exposed, whether at home or in day care, and varied inversely with birth weight, maternal age, level of maternal education, a socioeconomic index, and duration of breastfeeding.<\/jats:p><jats:p>After adjustment, using multivariate analysis, the only variables that each remained independently and significantly related to the cumulative proportion of days with MEE were: during the first year of life, study site grouping, sex, the socioeconomic index, breastfeeding for \u22654 months, the number of smokers in the household, and an index rating the degree of exposure to other children at home or in day care; and during the second year of life, sex, the socioeconomic index, and the child exposure index. The duration of breastfeeding and the degree of exposure to tobacco smoke contributed little to the explained variance; most was attributable to differences in the socioeconomic index and the child exposure index.<\/jats:p><jats:p>Conclusions.\u2003Contrary to findings in many previous reports, the prevalence of otitis media during the first 2 years of life among lower-socioeconomic-status black infants appears to be as high as, if not higher than among lower-socioeconomic-status white infants, and certainly higher than among middle-class white infants. Among middle-class white infants the prevalence may also be higher than commonly assumed. The most important sociodemographic risk factors for otitis media appear to be low socioeconomic status and repeated exposure to large numbers of other children, whether at home or in day care.<\/jats:p>","DOI":"10.1542\/peds.99.3.318","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:40:17Z","timestamp":1092440417000},"page":"318-333","source":"Crossref","is-referenced-by-count":531,"title":["Otitis Media in 2253 Pittsburgh-Area Infants: Prevalence and Risk Factors During the First Two Years of Life"],"prefix":"10.1542","volume":"99","author":[{"given":"Jack L.","family":"Paradise","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; the"},{"name":"Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard E.","family":"Rockette","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Kathleen","family":"Colborn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly S.","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde G.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Audiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia","family":"Kurs-Lasky","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine E.","family":"Janosky","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1997,3,1]]},"reference":[{"key":"2021120819155883900_B1"},{"key":"2021120819155883900_B2"},{"key":"2021120819155883900_B3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0065-3101(24)00283-4","article-title":"Does early-life otitis media result in lasting developmental impairment? Why the question persists, and a proposed plan for addressing it.","volume":"39","author":"Paradise","year":"1992","journal-title":"Adv Pediatr."},{"key":"2021120819155883900_B4","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/S0022-3476(87)80226-3","article-title":"On classifying otitis media as suppurative or nonsuppurative, with a suggested clinical schema.","volume":"111","author":"Paradise","year":"1987","journal-title":"J Pediatr."},{"key":"2021120819155883900_B5","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.1093\/clind\/15.Supplement_1.S62","article-title":"Treatment guidelines for the evaluation of new anti-infective drugs for the treatment of respiratory tract infections.","volume":"15(suppl 1)","author":"Chow","year":"1992","journal-title":"Clin Infect Dis."},{"key":"2021120819155883900_B6","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0165-5876(85)80071-9","article-title":"A longitudinal study of the detection of otitis media in the first two years of life.","volume":"10","author":"Wright","year":"1985","journal-title":"Int J Pediatr Otorhinolaryngol."},{"key":"2021120819155883900_B7","first-page":"P27","article-title":"Consequences of differing tympanographic classification criteria in diagnosing middle-ear effusion.","volume":"148","author":"Paradise","year":"1994","journal-title":"Arch Pediatr Adolesc Med."},{"key":"2021120819155883900_B8","first-page":"P31","article-title":"Tympanometric detection of middle-ear effusion (MEE) in the first vs the second year of life.","volume":"148","author":"Paradise","year":"1994","journal-title":"Arch Pediatr Adolesc Med."},{"key":"2021120819155883900_B9","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1542\/peds.58.2.198","article-title":"Tympanometric detection of middle-ear effusion in infants and young children.","volume":"58","author":"Paradise","year":"1976","journal-title":"Pediatrics."},{"key":"2021120819155883900_B10","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1542\/peds.69.3.351","article-title":"Modified schema for classifying positive-pressure tympanograms.","volume":"69","author":"Smith","year":"1982","journal-title":"Pediatrics."},{"key":"2021120819155883900_B11","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1001\/archpedi.1992.02160160053013","article-title":"Assessment of otoscopists' accuracy regarding middle-ear effusion.","volume":"146","author":"Kaleida","year":"1992","journal-title":"Am J Dis Child."},{"key":"2021120819155883900_B12","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1056\/NEJM199404283301725","article-title":"Multiple-antibiotic-resistant pathogenic bacteria: a report on the Rockefeller University Workshop.","volume":"330","author":"Tomasz","year":"1994","journal-title":"N Engl J 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media.","volume":"14","author":"Bush","year":"1980","journal-title":"Pediatr Res."},{"key":"2021120819155883900_B37","first-page":"297","article-title":"Recurrent middle-ear infections in infants: the protective role of maternal breast feeding.","volume":"62","author":"Persico","year":"1983","journal-title":"Ear Nose Throat J."},{"key":"2021120819155883900_B38","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/00006454-198503000-00009","article-title":"Infectious illnesses in the first two years of life.","volume":"4","author":"Fosarelli","year":"1985","journal-title":"Pediatr Infect Dis J."},{"key":"2021120819155883900_B39","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/00006454-198601000-00006","article-title":"Risk factors for recurrent otitis media.","volume":"5","author":"St\u00e5hlberg","year":"1986","journal-title":"Pediatr Infect Dis J."},{"key":"2021120819155883900_B40","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1136\/bmj.303.6809.1032","article-title":"Passive smoking and otitis media with effusion.","volume":"303","author":"Barr","year":"1991","journal-title":"Br Med J."},{"key":"2021120819155883900_B41","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1542\/peds.91.5.867","article-title":"Exclusive breast-feeding for at least 4 months protects against otitis media.","volume":"91","author":"Duncan","year":"1993","journal-title":"Pediatrics."},{"key":"2021120819155883900_B42"},{"key":"2021120819155883900_B43","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/S0140-6736(51)92212-X","article-title":"Infant morbidity and mortality: a study of 3266 infants.","volume":"1","author":"Robinson","year":"1951","journal-title":"Lancet."},{"key":"2021120819155883900_B44","doi-asserted-by":"crossref","first-page":"699","DOI":"10.2307\/4593943","article-title":"Epidemiologic studies of otitis media among Eskimo Children.","volume":"85","author":"Reed","year":"1970","journal-title":"Public Health Rep."},{"key":"2021120819155883900_B45","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1111\/j.1651-2227.1979.tb18439.x","article-title":"Prospective studies of the effect of breast feeding on incidence of infection and allergy.","volume":"68","author":"Chandra","year":"1979","journal-title":"Acta Paediatr Scand."},{"key":"2021120819155883900_B46","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1056\/NEJM197905173002001","article-title":"Persistence of middle-ear effusion after acute otitis media in children.","volume":"300","author":"Shurin","year":"1979","journal-title":"N Engl J Med."},{"key":"2021120819155883900_B47","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3109\/00016487909137183","article-title":"Screening tympanometry during the first year of life.","volume":"88","author":"Tos","year":"1979","journal-title":"Acta Otolaryngol."},{"key":"2021120819155883900_B48","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/00034894800890S304","article-title":"Epidemiology of otitis media in children.","volume":"89(suppl 68)","author":"Teele","year":"1980","journal-title":"Ann Otol Rhinol Laryngol."},{"key":"2021120819155883900_B49","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1111\/j.1651-2227.1982.tb09476.x","article-title":"Prolonged breast feeding as prophylaxis for recurrent otitis media.","volume":"71","author":"Saarinen","year":"1982","journal-title":"Acta Paediatr Scand."},{"key":"2021120819155883900_B50","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/S0022-3476(84)80475-8","article-title":"Course and outcome of otitis media in early infancy: a prospective study.","volume":"104","author":"Marchant","year":"1984","journal-title":"J 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